If you asked me what my single biggest fear about childbirth was, it was tearing! I was terrified. So, being the person that I am, I combated that fear by doing all the research to prepare my body the best I could so I would minimise the chances of an injured perineum.
The perineum is the area between the vaginal opening and the anus
The good new is, there are options! It is also important to remember that our vaginas are ACTUALLY MADE for giving birth. Nobody bats an eyelid when a penis enlarges and doesn’t tear. No big surprise, right? Well, our vaginas can do the very same. Here are some tips how to aid the process:
From about 32 weeks, perineal massages can help prepare your body for birth. Although there is mainly anecdotal evidence to suggest that it makes a difference, it most certainly gives you an idea of the sensation of crowning. You can do this on your own or get your partner involved!
There is no need to buy expensive oils, a good quality almond oil or coconut oil without any additives is just as good.
Make sure your hands are clean and fingernails thoroughly trimmed. Apply some oil to your fingers, thumbs and perineum and insert two fingers about 3cm to 4cm deep into the vagina. Apply gentle but firm pressure on the area towards the anus and, at the same time, gently stretch the perineum outwards by pulling two fingers apart. Keep applying this pressure for about 2 to 3 minutes, changing the side of the perineum you put pressure on after a few stretches, like going around a clock.. Next, put your thumbs in the middle of the perineum, pushing them in opposite directions. This should not hurt, only apply pressure until you feel a tingling sensation. Over time you will be able to increase the pressure.
Active pushing during the second stage of labour, especially when laying on your back and even more so with your legs raised, greatly increases the risk of tearing and unnecessary trauma to the perineum. Choosing a position where you work with gravity rather than against it is so much gentler on your body.
Breathe the baby out!
The uterus is the most powerful muscle in our body. In most cases it is not actually necessary to push. At all! There is this wonderful thing nature has put in place called the Fetal Ejection Reflex. Your contractions alone are strong enough to move the baby through the birth canal and into the world. Hard to believe? It’s true. And it hugely reduces any risk of perineal trauma.
If at all possible, utilise the bath, shower or birthing pool. Warm water softens the perineum and relaxes the body, thus softening the tissue and allowing it to stretch.
When I gave birth to my third baby, my wonderful midwife used warm compresses against my perineum to maximise stretching, soften and support the tissue as baby passess through. It is worth asking your provider if they are comfortable doing this for you and if their policy allows it.
Episiotomy - if perineal trauma can’t be avoided
An episiotomy is where your midwife or obstetrician makes a surgical incision in your perineum and the vaginal wall to quickly enlarge the opening. In some situations perineal trauma simply cannot be avoided however an episiotomy rarely has benefits over natural tearing. Natural tears carry less risk and heal better due to the jagged edges of the wound as opposed to a clean cut.